Adherent Sleep Apnea Patients – What is the effect of diagnosis and adherence

level on inpatient outcomes?

Adherent But…

A Genesis Medical Center Research Study

And the Variables Affecting this Category of Patients

Presented by Jon Lemke, PhD and Desyree Weakley, RN, CCRC

Contributions by Alyssa Barkalow, RT and Neil Flynn

Sleep Apnea Risk Groups

3. No Dx-Probable Sleep Apnea

4. No Dx-Unlikely to have Sleep Apnea

1. Dx-Adherent

2. Dx-Nonadherent

6/18/2015

Lemke, GHS Business Intelligence Center

Adherent Sleep Apnea Patients – What is the effect of diagnosis and adherence level on inpatient outcomes?

Adherent But…

A Genesis Medical Center Research Study

And the Variables Affecting this Category of Patients

Presented by Jon Lemke, PhD and Desyree Weakley, RN

Contributions by Alyssa Barkalow, RT and Neil Flynn

Adherent?

YES, AND … !

Adherent…But… Equipment is malfunctioningBut… Not using equipment properlyBut… Noncompliant usageBut… Cushion is leakingBut… Headgear is stretchedBut… Unsure when to replace

suppliesBut… Unsure of insurance coverageBut… Do not take it when traveling

Adherent…But… “I just got my machine”But… “I don’t need it every night”But… “I take it off in the middle of night”But… “I fall asleep on the couch and

forget to use it”But… “I feel claustrophobic”But… “I don’t like my mask”But… “I’m in the hospital, I don’t need it”But… “I had heart disease before I got

my PAP”

Major Diagnostic Category

Adherent Nonadherent Probable Unlikely Cases

Elective 128 85 98 675 986

Nonelective 545 616 697 2,789 4,647

All Circulatory System

673 701 795 3,464 5,633

Odds Ratios          

SA Dx or Probable vs. Unlikely

1.44(1.19 , 1.76)

More Likely to Have Sleep Apnea

SA Dx vs. Probable

0.77(0.54 , 1.08)

Less Likely to Have a Diagnosis of Sleep Apnea

Adherent vs. Nonadherent

0.59(0.39 , 0.87)

Less Likely to be Adherent

Circulatory System: Nonelective 7.17 times the OFI’s than Elective

Presentation ObjectivesDiscuss Variables in the Adherent

Category (“Adherent But…”)Explain the Purpose and

Objectives of the Adherent, But… Study

Describe Sleep Apnea Adherence Relevant to Genesis CV Patients

Discuss Realities & Challenges of the Study

2/11/2015

Adherent - but

Lemke, GHS Business Intelligence Center

Study Purpose & Objectives

Categorize Adherent patients based on reason for sleep study referral & level of adherence into 4 groups by:◦Medically driven PAP treatment vs. non-

medically driven (sleep apnea symptoms)◦Fully adherent vs. not fully adherent

Identify & compare mortality rates, length of stay, complication rates, & 30 day readmission rates of each category

Identify number of Adherent patients who replace masks within 90 days

Study FlowGenesis cardiac patients with SA using PAP device =

AdherentEnter the CRCScreen CSU & CIU

Identify potential subject

Discuss pt with RN

Informed ConsentDecline

AdherentAdherent SurveyData collection: 90d SA history, H&P,

current admission, 30d re-admit, 90d

resuppliesNot Sleep Apneic

Non-Adherent

Other

The Journey so Far…Screening on CSU & CIU began May 27th

One week feet to the pavement:◦90 patients screened◦66 with no SA diagnosis

Unlikely Probable

◦18 classified as non-adherent◦3 declined participation◦1 documented Adherent identified as Non-

adherent◦1 documented SA Adherent identified as Cured◦1 enrolled - 1st patient on June 1st!

The prevalence of “Adherent But…”

Discrepancies◦Medical charts◦Patient accounts

“The Gap” – what patients say vs. what they do

Misclassifications and Biases

Challenges for PatientsOld EquipmentRe-ordering Supplies

◦Medicare requirements i.e. Medicare requires repair of machines

before replacements or proof that device is unfixable

◦Incorrect Dictations i.e. Patient’s office visit states recently

acquired new PAP device but patient did not; now must wait for corrected dictation or make another office visit

Barriers of Data CollectionDevices

◦Supplies obtained outside GHS◦Device not brought to hospital

At home Family cannot bring in With manufacturer for repair

Patient Historians◦Remembering reason for initial sleep

study referral◦Recalling how often supplies reordered

Retrieving PAP DataThe Bad News - some devices are

too vintage to store dataThe Good News

◦Devices that are too old are not seen as frequently

◦Most devices can download data to a portable memory card

◦Some new top-of-the-line models can upload to ‘The Cloud’

Potentials to Improve Adherence

Brightree Connect – enhanced communication & automated re-supply

Clinicians available M-F 8:30am-6pmIncreased knowledge of Primary Care

PhysiciansSleep Clinic ReferralsAdding a Respiratory Therapist to

Genesis West GHME locationMoving Silvis GHME site to a more

convenient Moline location

Medicare Allowable Reimbursement

Can’t we all sleep so soundly?